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On February 1, 2003, the Shuttle Columbia disintegrated upon re-entry into the Earth's atmosphere, and the seven astronauts onboard lost their lives. Explores Columbia's final mission from the perspective of six key managers and engineers associated with NASA's Space Shuttle Program. An introductory video and interactive timeline present background information. An application replicates the desktop environment of six real-life managers and engineers involved in decision making during the period prior to Columbia's re-entry. Each user is preassigned a particular role and, through a password system, enters the role-play application. Users review the protagonists' actual e-mails, listen to audio re-enactments of crucial meetings, and review space agency documents. Users must be prepared to play the role of the protagonist in a classroom re-enactment of a critical Mission Management Team meeting that took place on Flight Day 8 (January 24, 2003). Users examine the organizational causes of the tragedy rather than focus on the technical cause. May be used with HBR article: Facing Ambiguous Threats (product #R0611F)

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learning objective:

To enhance understanding of organizational decision making and learning as well as catastrophic failures; to help students understand how failures can evolve; to think about how to prevent failures in an organization; and to examine how to manage crises effectively. Also, to learn leadership behavior and how to build an organization that is less susceptible to significant preventable failures.

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This case presents financial statements and selected ratios for 14 unidentified healthcare organizations and asks that each set of financial information be matched with one of the following healthcare companies: a biotechnology firm, a community nursing company, a distributor (medical), a DME licensee and seller, a DME developer and seller, a home care provider, a hospital (diversified), an insurer, a lab/diagnostic firm, a medical device manufacturer, a nursing home operator, a pharmaceuticals company (branded), a pharmaceuticals company (generics), and a private practice.

learning objective:

To learn the fundamentals of financial analysis (and financial health) of healthcare organizations by predicting the 14 healthcare firms that are represented by 14 sets of financial statements.

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In 2010, Andre Razafindranaly, Managing Director of a large French public hospital, considers which organizational structure will help them adjust to the changing health sector environment. The move from global budget to activity-based funding has led his and many other public hospitals to suffer losses in recent years. Appointed two years previously, Razafindranaly introduced increasing financial control and encouraged organizational changes such as multidisciplinary wards differentiated by patients' lengths of stay. To what extent should he (and can he) reinforce these measures, which have increased efficiency and reduced the deficit, but also generated push-back from his doctors and staff?

learning objective:

To introduce students to the challenge faced by public health institutions in a changing regulatory and competitive environment.

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In 2000, Dr. Gary Kaplan became CEO of the Virginia Mason Medical Center in Seattle, Washington. The hospital was facing significant challenges: It was losing money for the first time in its history, staff morale had plummeted, and area hospitals presented ardent competition. Considerable change was imminent. Within his first few months, Kaplan had rallied the organization around a new strategic direction: to become the quality leader in health care. What Kaplan and his administrators lacked was an effective tool to execute their strategy. Soon thereafter, a series of serendipitous events led to the discovery of the Toyota production system, and the Virginia Mason Medical Center became entrenched in an overwhelming challenge: how to institute a production model in health care.

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Through its uniquely proactive approach to medical malpractice risk management, the Risk Management Foundation has decreased claims-and premiums-for the Harvard hospitals it insures. The RMF is the captive medico-legal insurer of the Harvard medical institutions and affiliated physicians. Over the last two decades, through a combination of active legal defense and medical error prevention, The RMF has successfully controlled the medico-legal costs of physicians practicing at the Harvard teaching hospitals; consequently, its insured physicians pay notably lower premiums than similar specialists outside the Harvard system. The RMF's success has been due, in large part, to the close working relationships it has cultivated with the insured physicians and hospitals. However, as the hospitals expand their networks into Boston's suburbs, new, less tightly affiliated doctors whose medico-legal risk is higher than those practicing at the hospitals are coming under RMF's umbrella. This case describes The RMF's approach to risk management and the challenges its managers face in accommodating these new physicians.

learning objective:

Describe the medical malpractice insurance industry through the lens of one insurer's innovative approach to managing malpractice risk by improving patient safety.

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Today's health-care providers face growing criticism - from policy makers and patients alike. As costs continue to spiral upward and concerns about quality of care escalate, the debate has focused on how to finance health care. Yet funding solutions can't address the underlying questions: Why have costs risen in the first place? And how can we improve the quality and affordability of care? In Designing Care, Harvard Business School professor Richard Bohmer argues that these fundamental questions must be answered. A medical doctor himself, Bohmer explains that health-care professionals are tasked with providing two very different types of care - sequential and iterative. With sequential care, a patient can be quickly diagnosed and given predictable, reliable, and low-cost care. But in the case of iterative care, a patient's condition is unknown, and tremendous resources may be required for diagnosis and treatment, often with uncertain outcomes. Bohmer shows that to reduce costs and manage care effectively, sequential and iterative care situations require different management systems. Through stories and cases drawn from years in the field, he reveals how health-care providers can successfully manage both modes. To do so, they must reevaluate traditional roles and embrace continuous learning across the organization. The benefits of this operational redesign? The predictable, responsive, and lower-cost care today's health-care leaders - and patients - seek.

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How will Newton-Wellesley Hospital (NWH) preserve its private practice tradition while remaining effective and competitive in a healthcare industry demanding increasing integration between physicians and hospitals? This is the decision facing Newton-Wellesley Hospital president Mike Jellinek in 2009, as several trends-higher costs and lower revenues, shifting workforce demographics, and changing reimbursement models-threaten to disrupt NWH's organizational model. Similar to other U.S. community hospitals, NWH has historically been staffed primarily with private practitioners; however, in recent years Jellinek has taken several steps toward further integration, such as hiring primary care physicians and hospitalists, and even proposing formation of a physicians' organization (PO)-a move its veteran private practitioners sharply oppose. In 2009, NWH is renowned for high-quality care and is financially strong; yet, given external pressures, most at the hospital agree that reforms are needed to improve the hospital's and physicians' profitability while maintaining highest-quality patient care. Diverging opinions over how to improve the hospital has exposed differences between some private practice physicians and the administration. The crux of their disagreement centers on one question: how to make the organizational changes required to keep NWH effective and competitive in the face of a diminishing revenue growth rate, while honoring its tradition of physician independence.

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Intermountain Healthcare is a 21-hospital integrated delivery system serving Utah and southern Idaho that is nationally recognized for its highly structured approach to managing the quality of clinical care. This case describes Intermountain's system for improving clinical performance that makes use of the organization's extensive set of standardized clinical protocols and associated clinical process and outcome measures. The measures underpin a sophisticated set of financial incentives that are applied to both administrative and clinical staff. The case allows students to evaluate the strengths and weaknesses of financial incentives in clinical medicine.

learning objective:

1. Understand the strengths and limitations of pay-for-performance in healthcare delivery. 2. Examine a deliberate and highly structured approach to managing clinical performance of a healthcare delivery organization.

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Partners in Health is a Boston-based, not-for-profit that provides health care to people in some of the poorest regions of the world, including Haiti, Malawi, Rwanda, and Peru. In 1998, PIH established a program (PACT) in Boston to bring care to AIDS and TB patients who were not well served by existing care delivery systems. Describes PIH's programs in the developing world and the way in which lessons learned in these countries informed the design and management of PACT. Examines the balance between customized and standardized approaches to care and challenges students to examine their preconceived notions of the social role of a health care delivery organization. Dr. Heidi Behforouz, PACT's director, must decide whether a service design honed in developing countries can be rolled out more broadly in one the world's richest nations.

learning objective:

To examine the applicability to the developed world of approaches to health care delivery honed in poor nations.

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